'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

NICE drives up SSRI prescribing

Publication of NICE guidance on depression and anxiety appears to have significantly forced up GP prescribing of SSRIs.

An audit of 23,217 patients in the North East found the proportion prescribed SSRIs increased from 46.5 to 59.4 per cent in the six months after publication.

But the guidance, published in December 2004, appears to have had a patchy effect on prescribing. The proportion of patients on venlafaxine fell from 7.3 to 1.0 per cent after advice that GPs should only prescribe the drug in collaboration with a specialist.

But prescribing of dosule-pin, after similar recommendations, fell only marginally and not significantly, from 3.7 to 3.2 per cent.

Dr Hamish McAllister-Will-iams, a reader in clinical psychopharmacology at the University of Newcastle, who con- ducted the audit, said: 'My view is dosulepin is a far more risky drug than venlafaxine and it's concerning that either GPs were not aware of NICE's recommendations or choosing not to follow them.'

Mr Stephen Pilling, joint-director of the National Collaborating Centre for Mental Health, said the increase in SSRI prescribing seemed larger than ideal but he was pleased with the reduction in use of venlafaxine.

'People who were being prescribed older drugs like venlafaxine are now been prescribed SSRIs, and that would be appropriate on safety grounds and in line with the recommendations.'

The audit was published as a research letter in October's British Journal of General Practice.